New Client Information

Pet Photo Release

We think your pet is PAWS-itively perfect and want everyone to know!
By signing this waiver, I give Village East Animal Hospital the right to use the photo(s) and name(s) of my pet provided for reproduction in any promotional medium including but not limited to; website, video, broadcast, print, and electronic means for purposes of advertising, trade, display, exhibition or editorial use. Further, you also (i) agree to release Village East Animal Hospital from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity or any other claim and (ii) confirm that you are over the age of 18 years old.*

I agree.I do not agree.

Authorization to Release Veterinary Records
I hereby certify that I am the owner or authorized agent of the above pet(s). Further, I hereby request and authorize Village East Animal Hospital to release medical information including vaccination history for my pet(s) to the above entities. I release Village East Animal Hospital, their veterinarians and staff from any and all legal liability for the release of information to the extent indicated and authorized herein. I may revoke this authorization in writing at any time.*

I authorize the release of my pet's medical records.I do NOT authorize the release of my pet’s Medical Records
Village East Animal Hospital is authorized to provide medical history including vaccination history when requested by the following: (mark all that apply.)

Other veterinary offices involved in the care of mypets.Boarding facilities that my pet may stay at.GroomingFacilities.Humane Societies/Shelters/Rescues.Other

Financial Policy Agreement

We will gladly prepare a written estimate if you desire. Feel free to ask for this with any of our staff.
I hereby authorize the veterinarian to examine, prescibe for, and treat my animal(s). I assumed responsibilty for all charges incurred in the care of my animals. I also understand that FULL PAYMENT IS DUE AT THE TIME OF SERVICE. I have read and understand this policy and I accept responisiblty for all fees. I understand that if I fail to pay as agreed, legal action will be taken against me.
Printed Name for E-Signature*

First NameLast Name
Today's Date*

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Are you a robot?*
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Client Information